CODE: 12.2 - Analysis of early and late post radiation urinary bladder toxicity in patients with invasive cervical cancer treated with concurrent radiochemotherapy
Article published in Urologia Polska 2006/59/Suplement 1.
Bogdan Torbé 1, Rafał Kurzawa 2, Danuta Rogowska 1, Marcin Słojewski 3, Mirosław Lewocki 4, Michał Falco 4, Andrzej Torbé 5, Andrzej Sikorski 3
- 1 Oddział Kliniczny Radioterapii PAM, Regionalny Szpital Onkologiczny w Szczecinie
2 Klinika Rozrodczości i Ginekologii PAM w Szczecinie
3 Katedra i Klinika Urologii PAM w Szczecinie
4 Oddział Kliniczny Radioterapii, Regionalny Szpital Onkologiczny w Szczecinie
5 Katedra i Klinika Położnictwa i Perinatologii PAM
- Introduction. For some years radiochemotherapy became to be a standard treatment in patients with advanced cervical cancer. The new method creates the fear of increased risk of reactions and post radiation complications, especially in urinary bladder and intestine.
- Objectives. The aim of the study is to evaluate the early and late post radiation complications of urinary bladder according to EORTC/RTOG classification in patients with invasive cervival cancer treated with concurrent radiochemotherapy in comparison with the group treated with radiotherapy alone in 36-months follow up.
- Materials and methods. Between July 2000 and November 2001 52 patients, aged 30 to 73 years (av. 50.5) with invasive cervical cancer staged IIB to IVA were treated with concurrent radiochemotherapy. The program of treatment was realized with support of Ministry of Health. The control group consists of 54 randomly chosen patients, aged 27 to 78 years (av. 57,4) treated between February 1999 and January 2002 with radiotherapy alone, according to conventional protocol. Radiochemotherapy comprised external irradiation of pelvis minor with four-field techniques with total dose 50.4 Gy/T fractionized with Mevatron accelerator photons 10-18 MeV in 1.8 Gy daily. Individual safety covers and central applicator cover during last two doses were used. The treatment was amended with gamma-brachytherapy with isotope Cs-137 and the dose 46 Gy in three applications (Paris technique) and cisplatin infusion (40 mg/m2) delivered every week. In the group treated with radiotherapy alone external small pelvic irradiation was applied (52-54 Gy/T) with individual safety covers and central applicator cover during 8 fractions. Gamma-brachytherapy was also applied with Cs-137 in two applications and total dose 50-55 Gy (Manchester technique). In both groups similar equipment and treatment planning conditions were employed. Early (during and 6 months after the treatment) and late (after more than 6 months) toxicity was evaluated on the basis of the Radiation Therapy Oncology Group (RTOG/EORTC) criteria.
- Results. Early post radiation toxicity was observed significantly more frequently in the group treated with concurrent radiochemotherapy (71%) comparing to 61% in the control group in the radiotherapy alone group. In both groups no early toxicity grade 3 or 4 was observed. Late toxicity was observed significantly more frequently in the group of patients treated with concurrent radiochemotherapy (94%) than in the group treated with radiotherapy alone (74%). The analysis of incidence of postradiation vagino-vesical fistulas showed no statistically significant differences between the two groups (5.8% vs 3.9%).
- Conclusions. 1. Use of cisplatin in combination with radiotherapy in patients with advanced cervical cancer is associated with higher rate of early and late bladder toxicity. 2. Due to increased rate of bladder toxicity, method of combination of radio and chemotherapy in advanced clinical stages of cervical cancer can unfavorably affects patients' quality of life during and after the treatment. 3. Due to significantly higher rate of early and late post radiation bladder toxicity in the group treated with radiochemotherapy, the need of using the techniques and procedures of application which reduces doses received by these organs, is essential.